My father has high blood pressure. His parents had high blood pressure. My mother has high blood pressure. Her parents had high blood pressure. So, it came as no surprise when in a 2010 annual check-up I had blood pressure readings of as high as 140/95. Instead of immediately prescribing medication, mostly because I had no other major risk factors, my doctor suggested that I purchase a home blood pressure monitor and take my blood pressure in a particular way and on a regular basis. I bought an Omron electric sphygmomanometer at Target for under $60 and began measuring my blood pressure, taking 3 readings at a time, 3 times per day, morning, afternoon, and evening. The 3 readings at a time, 3 times per day, are a much more accurate picture of actual blood pressure, as any one reading might be abnormally high or low. I’m certain statisticians can agree that larger sample sizes often lead to more accurate results. I recorded the readings in a spreadsheet that allowed me to calculate average and see time of day and longitudinal patterns.
While I am certain that the doctor’s recommendation was more aimed at gathering data, it turned out to be a prescription for awareness. Simply taking my blood pressure regularly made me more aware of this phenomenon that was always present inside me, which in my case lead to some more mindful choices. I was already a runner, yoga practitioner, and vegan. I’ve been running since I was a teenager, doing yoga since college, and eating vegan since 1995, all studied interventions for blood pressure reduction. But just doing these things in general was not enough to impede the encroaching family induced high blood pressure. What more could I do lifestyle wise?
First, I scheduled a consult with a registered dietitian. She had me do another data collection/awareness exercise, a 72 hour food diary with extremely precise descriptions of each food and each meal. I measured amounts, listed brands, and counted everything I ate and drank for that 72 hour period. While she did give me some very specific ways to change the way that I eat, which I will enumerate, the exercise itself, taking 72 hours to mindfully observe (without judging or changing anything in that 72 hour period) everything I was eating and drinking, had a profound effect on my awareness of what I was specifically consuming.
After my diet diary was complete I had my consult with the dietitian. She suggested, based on the data I had collected, that, even though I was already eating a plant based diet, I was consuming too much sodium, a known culprit in elevating blood pressure. As a result during my next several grocery shopping trips I made note of the sodium levels in some of the foods I had been consuming. While I did do some elimination of a few processed items, I mostly just shifted from one brand to another, or the low-sodium version of a product. I know that many people would rather “just take a pill” than give up some of their “favorite foods.” Although I would have eventually acquiesced to taking medication if lifestyle interventions proved inadequate, I was determined not to end up on prescription blood pressure medication. I wanted to see if simply changing my choices could impact my physiology.
What I also learned from the diet changing process is that taste and food favorites are not fixed. Once I had reduced sodium levels for a couple of months, I no longer noticed the missing salt. In other words, my taste buds and brain had adapted to the new circumstance. Foods that I once found delicious (like certain frozen enchiladas and pizzas) now tasted too salty and foods that I had found bland now tasted just right. I am certain that some of you will attribute this to some kind of placebo effect, that I wanted the bland food to taste good, so it did. I don’t think so. I think my taste buds and brain chemistry changed. Even dishes that I have never eaten will now taste too salty to me while not salty enough to some of my friends. This cannot be explained by placebo alone.
Still, others, in defense of their own lifestyle choices will critique mine. They will exclaim that I am missing out, that I am deprived, that I don’t know what I am missing. In my place, they would make a different choice. They would risk the higher blood pressure for the convenience meal, or the social comfort of sharing in those foods with friends and family. That is their choice to make. While it is not my choice, I accept that others will make it. This exposition is not for them. It is for those of you who understand and connect with my desire to be in control of my own life, my own body, and who have the desire to do the same, but lack the tools and support to do so.
As I took more control over food choices, I also made changes to my running routine. The biggest and most profound change I made was to create and stick to an exercise schedule, no matter what. I did increase the intensity and duration of my runs, but not by much and not anything close to extreme. I run 2 times per week, between 2 and 4 miles each time. What has proved most effective is not how far or intensely I run, but simply that I show up for the routine regardless of circumstances. For example, if I am injured, or just run down, I do not “take a day off”. Instead, if it is my scheduled time to run, I go to the same place that I usually run and either walk for the same amount of time I would have run, or if I am so sick that I cannot or should not spend that much time exerting myself, then I show up at the usual place, at the usual time, and just stand and breathe in the fresh air for a few minutes. I have found that it is keeping the schedule that has been most effective in supporting not only my lowered blood pressure, but also my sense of wellbeing.
I also began scheduling consistent, but not necessarily frequent, acupuncture and massage, once per month each. Once a month I go to the acupuncturist to help keep my blood pressure in check. I have found that acupuncture can be a very powerful tool for affecting the nervous system. Similarly, I began scheduling 1 massage per month, with an emphasis on relaxation and blood pressure reduction (rather than deep tissue muscle release for example). During these sessions I begin with visualizing the release of tension from my body and end up very often (almost always) drifting off into a very restful sleep. Like with running, I have found that, as much as the acupuncture and massage practices are specifically helpful, it is the routine of keeping these appointments that has bolstered a consistent path of self care.
Like the changes I made to my running routine, I made similar changes to my practice of yoga. While I have had a practice for some time, there was a period when it was more haphazard and less consistent. Once I got the blood pressure warning, I started scheduling a more regular yoga practice. I have said for a long time that 80% of the benefit of doing yoga comes from just doing yoga, and that you can adjust the intensity and duration to tweak the other 20% of the benefit if you want. Philosophers, sages, thinkers and people of good common sense have had it right: “The perfect is the enemy of the good.” So, I set a routine to do a little bit of yoga 5 days per week. The standard I started with was set around my family responsibilities. At that time I needed to start prepping breakfast and lunches at 7:30 a.m. So I decided that my practice would start at whatever time it could and always end at 7:30. Some mornings I would get up and start practicing by 6:30, but most morning I would start around 7:05. Sometimes I wouldn’t be able to start until 7:26 and I would contemplate just scrapping it altogether, but then I realized that the routine mattered more than the duration. So I would practice for 3 or 4 minutes and then end at 7:30. Other times when I did end up scrapping the practice altogether for the day, I would be more irritable, moody, stressed, and inevitably my blood pressure readings would be elevated. In other words, even just 3 or 4 minutes made a dramatic impact in lowering my blood pressure! Don’t get me wrong, I am not starting a new fad “3 Minute Yoga!” There are times when a longer practice really helps and makes a bigger difference. I’m simply suggesting that an all or nothing attitude is ultimately destructive.
Having said that, I did make some changes to the type of postures I practice in order to positively impact my blood pressure. For example, I started prioritizing the inclusion of more inverted postures: headstand 1, headstand 2, handstand, forearm stand, and shoulder stand. People with excessively high blood pressure above 145/95 should avoid fully inverted postures. When one first goes upside down, cerebral blood pressure is increased. This increases the risk of stroke for those who already have extremely high blood pressure. However, after a few moments upside down, the body readjusts to the new circumstance and blood pressure lowers. This lowering effect is magnified as inverted postures are practiced longitudinally (over time). While there is a complex physiology as to why this happens, including baroreceptors and the autonomic nervous system, the main point is that by practicing inverted postures I was retraining my body to lower its own blood pressure. I also included some specific forward bends to have a similar blood pressure positive effect.
Additionally, and perhaps most importantly, I made adjustments to my practices of breathing (pranayama) and meditation, like including them. While in the past sitting in meditation was an afterthought, I began front-loading a sitting practice before moving through yoga postures (asana). Meditation can be just an important a tool as physical exercise when reducing blood pressure. Sometimes I would sit with my sphygmomanometer (blood pressure monitor) going and experiment with different ways of breathing to observe which breathing practices best lowered my blood pressure. Longer inhalation as compared to exhalation increased my blood pressure and longer exhalation as compared to inhalation decreased my blood pressure. As a result of these self experiments, I started engaging a breathing pattern of elongating the exhalation with relationship to the inhalation. I also experimented with different meditation foci. While many topics of meditation/contemplation had a positive effect on lowering my blood pressure, some that seemed to lower it most and most consistently are thinking of my loved ones and how I love them, broadening my view of nature and the natural world, and whatever makes me smile.
I suspect that comedy is like aerobic exercise or practicing inversions. In the short term it elevates blood pressure, because you are laughing and the breath is shortened, but in the long term it lowers blood pressure. I have just some scant evidence from my own blood pressure readings, but would love to see a study on this. Perhaps I could even participate!
Today, as I write this, my blood pressure reading is 113/74. It is my hope that my personal example of change and self determination will be of support and inspiration to those of you who are engaged in similar struggles. You can make change, big change, and it can be made without tremendous shifts in your life. Laugh. Meditate. Breathe. Do some yoga (any yoga). Get outside. Think about what you are eating before, during, and after you eat it. Make commitments. Be consistent. Be dedicated. Be mindfully aware.